A new study published in the latest issue of The American Journal of Managed Care®found that Medicare annual wellness visits were associated with lower overall healthcare costs and improved clinical care quality for senior patients at two of Aledade’s physician-led accountable care organizations.

Bethesda, MD (March 8, 2019) – A new study published in the latest issue of The American Journal of Managed Care®found that Medicare annual wellness visits (AWVs) were associated with lower overall healthcare costs and improved clinical care quality for senior patients at two of Aledade’s physician-led Accountable Care Organizations (ACOs). This is the first known study to estimate the association of AWVs with measures of cost and quality.

The study, conducted by Aledade, found that patients who received an initial AWV from primary care providers with ACO support experienced a meaningful reduction in adjusted total healthcare costs of 5.7 percent over eleven months, with the greatest association seen for the highest risk patients. For those who received an AWV, this association was driven by reduced hospital spending, including $30 in acute care and $20 in outpatient non-emergency care savings per patient per month, on average.

"Annual wellness visits helped these ACO primary care providers improve patient care and reduce spending. But nationally, only 16 percent of eligible Medicare beneficiaries had an annual wellness visit in 2014,” said Adam Beckman, the study’s co-lead author, consultant for Aledade, and a current medical student at Harvard Medical School. “These results demonstrate that conducting these visits–particularly with high risk beneficiaries–could help improve care for millions of seniors while reducing healthcare costs."

In addition, the study found that patients who had an AWV were also more likely to receive recommended preventive clinical services. For example, patients who received an AWV had a 70 percent higher screening rate for fall risk and depression than those who did not. The AWVs were associated with higher rates of A1C control, breast cancer screening, colorectal cancer screening, and tobacco use screening and cessation intervention.

“Annual wellness visits have been the cornerstone of many ACOs’ strategies for strengthening primary care relationships, improving quality of care, and reducing total cost of care. Now, our results show that they can be effective at doing just that,” said Dr. Farzad Mostashari, M.D., CEO and co-founder of Aledade. “It is important to note, however, that this took place in the context of primary care practices engaged in accountable care and supported with substantial population health training and tools.”

AWVs reimbursement codes were created to enable primary care practices to help patients stay healthy and out of the hospital by spending more time focused on prevention and wellness. This type of visit was introduced in 2011 by Medicare and made available to all eligible beneficiaries. According to Medicare policy, physicians receive approximately $175 in fee-for-service reimbursement for an initial AWV and each beneficiary is eligible for one AWV per year.

“Annual wellness visits give us the chance to take a step back from the typical illness, lab, or procedure-focused visits. These visits grant us the opportunity to look at the whole person in front of us–answering their questions, offering preventive service, and developing a plan to address any areas of concern,” said Dr. Richard Shorter of Melrose Family Medicine in Princeton, WV, one of the ACO member practices involved in the study. “Wellness visits help us transition from a reactive to a proactive mindset in addressing our patients’ healthcare needs.”

Methodology

In the study, the authors examined the association of an AWV with healthcare costs, utilization, and measures of clinical quality among 8,917 beneficiaries cared for by 44 primary care clinics in the Aledade Delaware ACO and Aledade Primary Care ACO between 2014 and 2016. Limitations include that the study design was not randomized and that these findings will not necessarily translate to all primary care settings. Future research can help guide policy with respect to whether AWVs should be billable only by the patient’s primary care physician and whether payment should be higher for higher-risk patients.

Founded in 2014, Aledade partners with independent practices, health centers, and clinics to build and lead Accountable Care Organizations (ACOs) anchored in primary care. Through these ACOs, Aledade empowers physicians to stay independent, practice medicine like they’ve always wanted to, and thrive financially by keeping people healthy. Aledade offers a comprehensive range of capabilities that include cutting-edge data analytics, user-friendly guided workflows, unparalleled regulatory expertise, strong payer relationships, and local, hands-on support from attentive experts. In true alignment with more than 4,000 participating providers in 24 states, Aledade shares in the risk and reward across over 35 value-based government and commercial contracts representing more than 500,000 lives under management. To learn more, visit www.aledade.com or follow on Twitter or Facebook.